Healthcare Provider Details

I. General information

NPI: 1003991787
Provider Name (Legal Business Name): DR JOSEPH CLIFTON BROOME PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 NW 23RD ST
BETHANY OK
73008-4942
US

IV. Provider business mailing address

RR 1 BOX 122B
CASHION OK
73016-9731
US

V. Phone/Fax

Practice location:
  • Phone: 405-787-4915
  • Fax: 405-787-6303
Mailing address:
  • Phone: 405-433-5607
  • Fax: 877-463-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23006
License Number StateOK

VIII. Authorized Official

Name: MR. JOSEPH CLIFTON BROOME
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-787-4915